Come on, Dr. Wu

Chapter 389 Red and Yellow Lights

Yu Shifu didn't know what to say anymore, after all, Wu Xiaofu had already said it before he could say anything.

To be honest, it's a bit too worry-free.

"Xiao Fu, you are getting engaged soon. As a teacher, you can't fail to show your appreciation. Take this. This is something your teacher's wife has kept for many years. It's for Xiao Ying. You are not allowed to refuse."

The news of Wu Xiaofu's engagement did not spread. After all, it was just an engagement, not a marriage. The power of the two families was extraordinary, so the impact still had to be controlled.

Therefore, Wu Xiaofu only planned to tell this news to a few close people.

Yu Shifu is one of them, and the other is Duan Hao. There are only a few of them in the hospital.

Looking at the thing Yu Shifu handed over, Wu Xiaofu subconsciously wanted to refuse. It was a bracelet, a jade bracelet. Don't think that jade bracelets are worthless. Those who know know that it is this kind of jade bracelet that can have a sky-high price. And this jade bracelet is obviously an old item at first glance.

It might be something that came as a dowry from his master's wife. Yu Shifu is not without a daughter. This bracelet should be passed down to their daughter in the future.

But Yu Shifu did not allow any explanation and directly stuffed it into Wu Xiaofu's hand, and the words he said did not allow Wu Xiaofu to refuse.

Wu Xiaofu didn't know whether to refuse or what to do for a moment.

"Teacher, this is too expensive."

"What's so precious about you? Your master's wife and I both treat you as our own child. To be honest, I have achieved some success in my life, but to this day, the thing I am most proud of is that I have accepted such an outstanding disciple like you. Your marriage is a big deal, and I, as a teacher, am no match for you.

What's the matter? Don't you regard the teacher as a relative? If you don't think so, then don't want him."

Upon hearing this, Wu Xiaofu hurriedly took the jade bracelet. Now that things have come to this, how can he refuse? He must accept it. When his junior sister gets married in the future, he will prepare a generous gift for her.

Yu Shifu was also satisfied when he saw Wu Xiaofu accept it.

He nodded, "That's right."

The two chatted for a while, and then Wu Xiaofu left. No one watched the show anymore. With the incident with Wu Xiaofu and glucose, the following shows would probably be overshadowed, and people's attention had been diverted.

Shaking his head, Wu Xiaofu's focus was, after all, on work and saving lives, and he couldn't be distracted too much by this.

In the operating room.

Feng Lingling performed the operation, which was just an ordinary laparoscopic cholecystectomy.

The patient is a 37-year-old young woman who was admitted to the hospital last Wednesday because of right upper abdominal pain, fever, and jaundice.

Looking at these three symptoms, at first glance, it seems to be Charcot triad, but it is worth noting that the patient's blood routine test showed that the patient was anemic. Such a case does not seem like an ordinary case. Zhang Xuewen felt it was inappropriate to do it in the outpatient clinic, so he admitted the patient directly to the hospital.

After admission, blood biochemistry tests showed that the patient's blood items were mainly characterized by elevated indirect bilirubin, which further confirmed the diagnosis of anemia.

In particular, we need to consider hemolytic anemia. When hemolytic anemia exists, cholecystectomy surgery still has many requirements.

The B-ultrasound showed that the patient had gallstones and cholecystitis, and the common bile duct was not thick. However, it was unknown whether there were stones at the lower end because it was blocked by gastrointestinal gas and could not be seen clearly.

Since the patient had already been hospitalized, Zhang Xuewen arranged a further MRCP examination for the patient to confirm that there were no stones in the common bile duct.

The initial considerations for today's patients are gallstones, cholecystitis and hemolytic anemia. When these problems occur, hospitals generally have ways to deal with them. It is impossible to just ignore the anemia and perform surgery directly.

Even if it's just for routine sharing of responsibilities, the hematology department should be invited over.

Therefore, Feng Lingling, as the attending physician, consulted the hematology department and confirmed that the patient's hemolytic anemia was hereditary spherocytosis.

After a careful examination, the hematology department has clearly stated that the patient's anemia level is moderate and will not affect his life, and the patient also refused to undergo a splenectomy.

According to the hematology department, it should not affect the cholecystectomy surgery.

After all, the current cholecystectomy is not a major operation. Even if Feng Lingling performs the operation, it will not take more than an hour. Such an operation will basically not cause any accidents to the patient due to anemia during the operation.

So Feng Lingling scheduled the LC as planned. Zhang Xuewen would basically not participate in such a minor operation, so the operation was performed by Feng Lingling and the intern.

Feng Lingling didn't care about it. After working for more than a year, she was no longer the Feng Lingling who had just entered the clinic. Now she was experienced and had performed countless laparoscopic cholecystectomies. She was very familiar with it. Even though this case was a little special, Feng Lingling thought that it would not be a problem as long as she could get it done as soon as possible.

However, who would have thought that the patient’s current medical history was already a little special, and that something even more special would happen later.

It really proves the saying "things come after things".

Feng Lingling was seen performing the routine three-hole method to separate the adhesions step by step. Both Feng Lingling and Yuna could be said to be of the same lineage as Wu Xiaofu in laparoscopic cholecystectomy.

Whether it is separation or formal excision.

"Every time we see you perform surgery, we think we are seeing Director Wu. You have absorbed all the essence of Director Wu's surgery."

The patrol nurse said this with a smile. Feng Lingling raised her lips when she heard it, but she said that it was still a long way to go.

It is indeed still a long way to go. When Wu Xiaofu performs surgery, he always goes straight to the target. He emphasizes simplicity, directness and precision.

After seeing so much, Feng Lingling basically adheres to this principle. Because of Wu Xiaofu's teaching of various skills, Feng Lingling and her colleagues not only learn quickly, but their efficiency and success rate in performing surgeries are also beyond the reach of ordinary attending physicians.

After seeing the common bile duct clearly, Feng Lingling dissected the gallbladder triangle with ease, freed the cystic duct and cystic artery, and then severed them separately, using a combination of forward and reverse methods to separate the gallbladder from the gallbladder bed until only a bundle of tissue was connected to the gallbladder bed at the end of the gallbladder body. Everything went so smoothly.

At this moment, Feng Lingling just wanted to say, if Wu Xiaofu could help.

Although they said they were not as good as Wu Xiaofu, they believed they had learned some of the essentials. When it came to laparoscopic cholecystectomy surgery alone, Feng Lingling dared to say that no one was better than her as the director.

The operation was almost over with only one last stroke left, and it was about to have a perfect ending, but accidents always happened at the last moment.

Feng Lingling's hand fell, and the electric hook fell with it. The bundle of tissue was directly severed, and the specimen came down smoothly. But what was horrifying was that yellow liquid also flowed out.

Feng Lingling couldn't help but be terrified.

Among hepatobiliary surgery operations, the most numerous one is definitely laparoscopic cholecystectomy. After all, Chinese people have a better diet and have developed various habits. The number of gallstones can be said to be increasing day by day and remains high. With so many cases piled up, Chinese doctors say that they are second in the world in terms of cholecystectomy level, and no country dares to say that they are first.

Although laparoscopic cholecystectomy is only an entry-level operation for hepatobiliary surgeons, you should never underestimate it at any time, otherwise it will give you a taste of your own medicine.

Well, it means literally, really give some color to see.

Either red or yellow.

Please note that this is not a traffic light, red and yellow are not just signs.

The red color naturally means bleeding. There are blood vessels around the gallbladder. One cut may have severed the blood vessels, or some blood vessels may have fallen down due to carelessness during the previous freeing. If they were not clamped, bleeding is normal.

In the eyes of surgeons, red is actually not a big deal. After all, it is just bleeding and there are no large blood vessels here. There is no need to panic. After seeing it clearly, just deal with it.

But yellow is more deadly than red. It’s like a traffic light. When you see a red light, you stop far away. But when you see a yellow light, many times, your first reaction is not to stop and wait, but to step on the accelerator and rush forward. But who can know what the consequences of this rush will be?

If you are lucky, you can rush through and save dozens of seconds.

If you are unlucky, the result could be a car crash and death.

Just like the yellow liquid in front of his eyes, it really makes the patient bleed bile and sweat, and each one is enough to leave a deep impression on the doctor.

After all, the yellow liquid is bile. Once the knife was cut, the bile leaked out. What was the reason?
The gallbladder is ruptured? Don't be ridiculous. Before the operation, the root of the gallbladder must be exposed and then cut. With Feng Lingling's skills, how could it be off? So, it is most likely not a ruptured gallbladder.

Looking closely, the gallbladder is indeed intact.

What else is possible?
It's over! The bile duct is damaged!

This was Feng Lingling’s first reaction. There are only two parts that can leak bile. If it’s not the gallbladder, then it’s naturally the bile duct.

But during a cholecystectomy, you must not cut the bile duct. The bile duct will be needed in the future. The patient is only 37 years old. How are you going to explain yourself if you cut the bile duct of such a young woman?

Even though Feng Lingling had been practicing Qi cultivation for so long and had done a great job, she still broke out in a sweat the instant she did.

With a little hope in my heart, I inserted the gauze into the abdominal cavity and dipped it on the bed of the gallbladder. Indeed, bile was flowing out.

What else can I do? Call my superior.

It doesn't mean that the patient is doomed after the bile duct is cut. As a hepatobiliary surgeon, you will almost certainly encounter bile leakage. As long as the common bile duct is unobstructed and the drainage is unobstructed, there will be no problem. At least there is no need to worry about the patient's life.

However, Feng Lingling is far from being good at knowing how to keep the common bile duct unobstructed and how to minimize the patient's losses after cutting the bile duct.

"Call Director Zhang."

The nurse on patrol also knew something was wrong and hurriedly made a phone call, but when the call was connected, it said that Zhang Xuewen was also in surgery.

Feng Lingling did not dare to delay and hurriedly asked someone to call Wu Xiaofu again. She knew that Wu Xiaofu would definitely not be able to have the surgery at this moment.

When Wu Xiaofu received the call, he had just come out of Yu Shifu's office a few minutes ago. He was originally planning to go back to sign, but he did not dare to delay and went straight to the operating room.

"Hey! Luschka bile duct!"

Luschka bile duct?

Feng Lingling suddenly realized and finally understood why she was so unlucky.

The Luschka bile duct was named after the anatomist Luschka who first described it in 1863. It is also known as the cholecystohepatic duct or the aberrant bile duct of the gallbladder bed. This is very common in textbooks. It is named after the first person who discovered it. However, the people associated with these nouns are basically from the last century.

After all, with the development of medicine, there are very few anatomical structures that have not been discovered.

The Luschka bile duct is a tube that directly connects the gallbladder and the intrahepatic bile duct. Its gallbladder opening is often located in the middle and lower part of the gallbladder body. It often flows into the posterior segment of the right lobe of the liver. The diameter of the tube is about 1 to 2 mm. The incidence rate is actually not high or low, ranging from 5% to 30%.

When encountering Luschka bile duct, if the gallbladder is separated from the gallbladder bed in the hepatic fossa during cholecystectomy but is not discovered in time, and it is cut off and the stump is not treated, it may cause a series of complications.

For example, bile overflows from the gallbladder bed and flows out along the drainage tube after surgery, forming bile leakage;
For example, if a drainage tube is not placed, it can cause bile peritonitis;

Or if the bile leakage after surgery is not properly handled, it may cause subhepatic infection and abscess formation;
At the same time, since the Luschka bile duct is often accompanied by small arteries, if they are cut together and handled improperly, such as electrocoagulation hemostasis, the blood clot will fall off or melt after the operation, which may cause bleeding.

Therefore, when performing a cholecystectomy, you must be more careful. Once Luschka bile duct is found, it cannot be treated like an ordinary cholecystectomy.

The correct way to handle Luschka's bile duct is to first cut the capsule covering the gallbladder wall, and then use blunt force to gently separate and pull the gallbladder away from the gallbladder bed in the hepatic fossa.

You should pay attention at this time. If a cord-like object appears after pulling open the gallbladder, you must not cut it arbitrarily. You should ligate the two ends first and then cut it from the middle. At this time, the stump will shrink and heal itself later.

"If it has been cut off accidentally, then we need to find the stump where the bile is leaking and clamp and ligate it, or do an "8" suture together with the surrounding liver parenchyma. This way, bile leakage can usually be prevented."

Wu Xiaofu was talking as he was performing the operation. Yes, Feng Lingling had a problem at this step. She did not do a thorough dissection or complete separation, and with one cut, she directly cut off the Luschka bile duct.

Feng Lingling watched carefully but she was in a very low mood. She was really getting cocky. Wu Xiaofu never looked down upon any cholecystectomy operation. She wasn't even a master yet and her skills weren't even 30% of Wu Xiaofu's, yet she was getting cocky. She knew about the Luschka bile duct.

But even though she knew it, she didn't know whether she was too lucky or too unlucky, as she had never encountered it before. Then today, the Luschka bile duct really appeared, which directly taught her the most wonderful lesson in her life.

(End of this chapter)